Purpose.: We evaluated the diagnostic accuracy of macular ganglion cell-inner plexiform layer (GCIPL) measurements using a high-definition optical coherence tomography (Cirrus HD-OCT) ganglion cell analysis algorithm for detecting early and moderate-to-severe glaucoma. Methods.: Totals of 119 normal subjects and 306 glaucoma patients (164 patients with early glaucoma and 142 with moderate-to-severe glaucoma) were enrolled from the Macular Ganglion Cell Imaging Study. Macular GCIPL, peripapillary retinal nerve fiber layer (RNFL) thickness, and optic nerve head (ONH) parameters were measured in each subject. Areas under the receiver operating characteristic curves (AUROCs) were calculated and compared. Based on the internal normative database, the sensitivity and specificity for detecting early and moderate-to-severe glaucoma were calculated. Results.: There was no statistically significant difference between the AUROCs for the best OCT parameters. For detecting early glaucoma, the sensitivity of the Cirrus GCIPL parameters ranged from 26.8% to 73.2% and that of the Cirrus RNFL parameters ranged from 6.1% to 61.6%. For the early glaucoma group, the best parameter from the GCIPL generally had a higher sensitivity than those of the RNFL and ONH parameters with comparable specificity (P < 0.05, McNemar's test). Conclusions.: There were no significant differences between the AUROCs for Cirrus GCIPL, RNFL, and ONH parameters, indicating that these maps have similar diagnostic potentials for glaucoma. The minimum GCIPL showed better glaucoma diagnostic performance than the other parameters at comparable specificities. However, other GCIPL parameters showed performances comparable to those of the RNFL parameters.

Purpose. To compare the glaucoma detection ability of macular ganglion cell-inner plexiform layer (GCIPL) thickness measured with Cirrus spectral-domain optical coherence tomography (SD-OCT) with that of peripapillary retinal nerve fiber layer (RNFL) thickness in high myopia. Methods. In 49 highly myopic and 54 nonhighly myopic glaucoma patients—along with 78 healthy myopic subjects—two scans, including one macular scan and one peripapillary RNFL scan, were obtained using Cirrus SD-OCT. For 44 randomly selected glaucoma patients, three macular scans were taken for reproducibility measurements. The glaucoma detection abilities of macular GCIPL and peripapillary RNFL thicknesses were compared between the highly myopic and nonhighly myopic groups. Diagnostic power was assessed by area under the receiver operating characteristic (AUROC) curves and sensitivity. Repeatability was assessed by intraclass correlation coefficient (ICC) and coefficient of variation (CV). Results. All of the macular GCIPL and peripapillary RNFL thickness measurements excepting the 3 o'clock peripapillary RNFL sector showed an AUROC over 0.5. The best parameters for discriminating normal from glaucomatous eyes were inferior RNFL (0.906) and inferotemporal GCIPL (0.852) thickness in the highly myopic group, and average RNFL (0.920) and minimum GCIPL (0.908) thickness in the nonhighly myopic group. The best peripapillary RNFL and macular GCIPL thickness parameters showed no statistically significant differences. All of the ICCs of the macular GCIPL ranged between 0.96 and 0.99, and the CV was <3%. Conclusions. In cases of high myopia, the glaucoma detection ability of macular GCIPL thickness was high and comparable with that of peripapillary RNFL thickness.

Purpose. To evaluate and compare the diagnostic ability of Cirrus and Stratus optical coherence tomography (OCT) to detect localized retinal nerve fiber layer (RNFL) defects in patients with normal standard automated perimetry. Methods. This study included 55 eyes of 55 subjects with preperimetric localized RNFL defects and 55 normal control eyes of 55 age- and sex-matched subjects. Areas under the receiver operating characteristic curves (AUROCs) were calculated and compared. Based on the internal normative database from each device, the sensitivity and specificity for detecting preperimetric localized RNFL defects were calculated. Results. There was no statistically significant difference between the AUROCs for the best parameters from the Cirrus OCT (inferior thickness, AUROC = 0.728) and Stratus OCT (7 o'clock sector, AUROC = 0.760; P = 0.477). The sensitivity of the Cirrus OCT parameters ranged from 21.0% to 87.1% and that of the Stratus OCT parameters ranged from 4.8% to 30.7%, with the criterion of abnormal at the 5% level. Based on the normative database, the highest Cirrus OCT sensitivity was obtained with the deviation-from-normal map (sensitivity 87.1% and specificity 61.8%), and the highest Stratus OCT sensitivity was obtained with the TSNIT thickness graph (sensitivity 30.7% and specificity 85.5%). Conclusions. There were no significant differences between the AUROCs for Cirrus and Stratus OCT, indicating that the two devices have similar diagnostic potentials in preperimetric glaucoma. After comparison with their normative databases, Cirrus OCT had generally higher sensitivities; however, this was largely at the cost of lower specificities than Stratus OCT.

To determine the influences of myopia and optic disc size on ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (RNFL) thickness profiles obtained by spectral domain optical coherence tomography (OCT). One hundred and sixty-eight eyes of 168 young myopic subjects were recruited and assigned to one of three groups according to their spherical equivalent (SE) values and optic disc area. All underwent Cirrus HD-OCT imaging. The influences of myopia and optic disc size on the GCIPL and RNFL thickness profiles were evaluated by multiple comparisons and linear regression analysis. Three-dimensional surface plots of GCIPL and RNFL thickness corresponding to different combinations of myopia and optic disc size were constructed. Each of the quadrant RNFL thicknesses and their overall average were significantly thinner in high myopia compared to low myopia, except for the temporal quadrant (all Ps ≤0.003). The average and all-sectors GCIPL were significantly thinner in high myopia than in moderate- and/or low-myopia (all Ps ≤0.002). The average OCT RNFL thickness was correlated significantly with SE (0.81 μm/diopter, P < 0.001), axial length (-1.44 μm/mm, P < 0.001), and optic disc area (5.35 μm/mm2, P < 0.001) by linear regression analysis. As for the OCT GCIPL parameters, average GCIPL thickness showed a significant correlation with SE (0.84 μm/diopter, P < 0.001) and axial length (-1.65 μm/mm, P < 0.001). There was no significant correlation of average GCIPL thickness with optic disc area. Three-dimensional curves showed that larger optic discs were associated with increased average RNFL thickness and that more-myopic eyes were associated with decreased average GCIPL and RNFL thickness. Myopia can significantly affect GCIPL and RNFL thickness profiles, and optic disc size has a significant influence on RNFL thickness. The current OCT maps employed in the evaluation of glaucoma should be analyzed in consideration of refractive status and optic disc size.